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Make an Appointment
 
Your appointment will be confirmed through return e-mail or telephonic communication.
For further information on appointment, please dial  
Appointment :

8845242 & 8401680
Mobile: +8801713064593
Emergency HOTLINE : 10678
Emergency : 01911-555555
Ambulance : 01714-090000
You must fill the * marked fields to submit your request
Title: (Mr./Mrs./Ms./Dr./Prof.)
:
Patient's Full Name *
:
Father's/Husband's Name
:
Mother's Name
:
Date of Birth *
:
Sex
:
 Male Female
Marital Status
:
 Married Unmarried
Religion
:
 Islam Hindu Christian Buddhist Don't want to mention  
Nationality *
:
Passport No. ( If any )
:
Blood Group ( If known )
:
Country of Birth
:
Referred By *
:
Telephone *
:
Email *
:
Brief Description of your Problem *
:
Request for *
:
Specialty for consultation *
:
Doctor *
:
Preferred Date and Time for Appointment
:
 1st Preference
Date *
:
  
Time *
:
  
2nd Preference
Date *
:
  
Time *
:
  
Remarks
:

Please be informed that this submission of “Request for Appointment” will only be workable after confirmation by our “Appointment Call Center”. Confirmation of Appointment depends upon the availability of doctors at your preferred date and time.
HOTLINE : 10678
Phone : 01911-555555
Ambulance : 01714-090000
Appointment :  8845242
PABX :  8401661
FAX :  8401679
Master Health Check :  8401600
Chittagong info : 01713-064555
Sylhet info : 01713-047461
Bogra info : 01713-229988
Khulna info : 01713-489191
 
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